Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study
Authors: Iván D. Benítez, Jordi de Batlle, Gerard Torres, Jessica González, David de Gonzalo-Calvo, Adriano D.S. Targa, Clara Gort-Paniello, Anna Moncusí-Moix, Adrián Ceccato, Laia Fernández-Barat, Ricard Ferrer, Dario Garcia-Gasulla, Rosario Menéndez, Anna Motos, Oscar Peñuelas, Jordi Riera, Jesús F. Bermejo-Martin, Yhivian Peñasco, Pilar Ricart, María Cruz Martin Delgado, Luciano Aguilera, Alejandro Rodríguez, Maria Victoria Boado Varela, Fernando Suarez-Sipmann, Juan Carlos Pozo-Laderas, Jordi Solé-Violan, Maite Nieto, Mariana Andrea Novo, José Barberán, Rosario Amaya Villar, José Garnacho-Montero, Jose Luis García-Garmendia, José M. Gómez, José Ángel Lorente, Aaron Blandino Ortiz, Luis Tamayo Lomas, Esther López-Ramos, Alejandro Úbeda, Mercedes Catalán-González, Angel Sánchez-Miralles, Ignacio Martínez Varela, Ruth Noemí Jorge García, Nieves Franco, Víctor D. Gumucio-Sanguino, Arturo Huerta Garcia, Elena Bustamante-Munguira, Luis Jorge Valdivia, Jesús Caballero, Elena Gallego, Amalia Martínez de la Gándara, Álvaro Castellanos-Ortega, Josep Trenado, Judith Marin-Corral, Guillermo M Albaiceta, Maria del Carmen de la Torre, Ana Loza-Vázquez, Pablo Vidal, Juan Lopez Messa, Jose M. Añón, Cristina Carbajales Pérez, Victor Sagredo, Neus Bofill, Nieves Carbonell, Lorenzo Socias, Carme Barberà, Angel Estella, Manuel Valledor Mendez, Emili Diaz, Ana López Lago, Antoni Torres, Ferran Barbé
Journal: The Lancet Regional Health - Europe (2022)

The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae.Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months.Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01).Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae.ISCIII, UNESPA, CIBERES, FEDER, ESF.